Source: Brigham and Women’s Hospital
Summary: In a randomized controlled clinical trial, researchers found that patients treated with a form of bariatric surgery known as Roux-en-Y gastric bypass did significantly better.
People with worrisome levels of obesity and poor control of their type 2 diabetes face two dramatically different options to substantially improve their health: bariatric (weight loss) surgery or intensive lifestyle management. In a randomized controlled clinical trial, researchers from Joslin Diabetes Center and Brigham and Women’s Hospital found that patients treated with a form of bariatric surgery known as Roux-en-Y gastric bypass did significantly better, after 3 years, than patients provided with an intensive diabetes and weight management program. The Roux-en-Y gastric bypass procedure is done laparoscopically, through small cuts in the abdomen. Surgeons make a small pouch at the top of the stomach and connect the pouch to the middle of the small intestine. Patients who had the gastric bypass procedure had superior ability to sustain changes both in weight and blood sugar. The study findings were published in the journal Diabetes Care.
The paper provided the latest results from the SLIMM-T2D (Surgery or Lifestyle with Intensive Medical Management in the Treatment of Type 2 Diabetes) study, which randomly allocated 38 obese patients with type 2 diabetes to treatment either by surgery at BWH or through Joslin’s Why WAIT intensive lifestyle management program. These participants had an average weight of 230 pounds and body mass index (BMI) of 36.3. After 3 years, patients given surgery saw dramatically greater weight loss, averaging 55 pounds compared to 11 pounds for those in the lifestyle management intervention. The surgical cohort also lowered their hemoglobin A1c levels (a measure of blood sugar over several months) by an average of 1.79% compared to 0.39% for the lifestyle management cohort. Additionally, those given surgery showed significantly lower risk of coronary heart disease and stroke.
Lead author Donald C. Simonson, “Our study demonstrates that in patients with mild-moderate obesity and type 2 diabetes, gastric bypass surgery leads to a sustained reduction in weight, improvement in glycemic control, and decrease in cardiovascular risk compared to a medical diabetes and weight management program.”
More Information: Donald C. Simonson et al, “Clinical and Patient-Centered Outcomes in Obese Type 2 Diabetes Patients 3 Years After Randomization to Roux-en-Y Gastric Bypass Surgery Versus Intensive Lifestyle Management: The SLIMM-T2D Study”, Diabetes Care (2018). DOI: 10.2337/dc17-0487